title: Detection of esophageal varices using CT and MRI.
abstract: OBJECTIVE
  The development of esophageal varices in cirrhotic patients carries a significant risk of hemorrhage and associated morbidity/mortality. Universal endoscopic screening, however, is invasive and expensive. Conversely, cirrhotic patients often have imaging findings which suggest portal hypertension. The aim of this study was to evaluate the ability of CT and/or MRI to detect esophageal varices compared to EGD.
  
  
  METHODS
  Medical records from 2000 to 2007 were retrospectively reviewed. CT and/or MRI images were included if performed within 90 days of EGD. Two blinded, experienced radiologists were asked to review images for the presence of esophageal varices, as well as other findings associated with portal hypertension. Sensitivity, specificity, PPV and NPV were calculated using EGD findings as the gold standard.
  
  
  RESULTS
  A total of 195 patients and 142 patients met criteria for CT and MRI, respectively. The sensitivity of CT to detect EGD varices was 58-89%, but increased to 65-100% when specifically looking at large endoscopic varices. Overall specificity was 68-82%, but increased to 97-100% when applying ≥4 mm varices criteria. CT was superior to MRI in the detection of endoscopic varices; the addition of other portal hypertension stigmata did not improve results.
  
  
  CONCLUSIONS
  The exclusion of large endoscopic varices by CT, using standardized criteria, may obviate the need or frequency of EGD screening in select patient populations. Alternatively, CT findings highly suggestive of esophageal varices in cirrhotic patients may warrant further investigation and/or treatment. Further studies are needed to validate these findings.
authors.affiliation: Division of Digestive Diseases, Beth Israel Medical Center, First Avenue at 16th Street, 17-BH, New York, NY 10003, USA. lipp50@gmail.com
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Lipp
authors.forename: Arkady
authors.initials: A
authors.lastname: Broder
authors.forename: David
authors.initials: D
authors.lastname: Hudesman
authors.forename: Pauline
authors.initials: P
authors.lastname: Suwandhi
authors.forename: Steven A
authors.initials: SA
authors.lastname: Okon
authors.forename: Mitchell
authors.initials: M
authors.lastname: Horowitz
authors.forename: David J
authors.initials: DJ
authors.lastname: Clain
authors.forename: Patricia
authors.initials: P
authors.lastname: Friedmann
authors.forename: Albert D
authors.initials: AD
authors.lastname: Min
mesh_terms: D000368:Aged; D004932:Esophageal and Gastric Varices / Q000175:diagnosis* / Q000209:etiology; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*